High-deductible plans increase bad debt, hospitals say
August 12, 2013 | By Julie Bird
The growing popularity of high-deductible insurance plans is leaving more
hospitals stuck with unpaid bills, Kaiser Health News reported.>
"We have definitely been hearing from members that they are seeing an
increase in bad debt and even in charity care for people with high-deductible
health plans," Caroline Steinberg, vice president for trends analysis at the
American Hospital Association, told KHN. "A lot of these folks tend to
not understand the structure of their benefits until they get to the hospital,
and they're not covered as thoroughly as they thought."
The rate of workers in high-deductible plans has more than doubled since 2009
to 19 percent, KHN says, citing figures from the Kaiser Family
Foundation. The deductibles can be as high as $5,000 annually, although they're
meant to be offset at least in part by a tax-free health savings account.
"The number of accounts that we're seeing that relate to these
high-deductible plans has been building, and it has been putting pressure on our
bad debt levels," Daniel Cancelmi, financial chief at Tenet Healthcare, a
leading healthcare services organization that operates 49 hospitals and 129
outpatient centers across the country, told stock analysts last
week, KHN reported. "We've seen it building over the past
several years, and it's continued into 2013 as well."
Meanwhile, a study published in the journal Health Affairs
suggested that lower-income employees with high-deductible health plans were
getting sicker than ever because of putting off needed treatment to avoid
out-of-pocket costs.
The study cited figures different than the Kaiser Family Foundation, saying
one-third of U.S. workers now have high-deductible health plans, with the number
expected to grow next year as more features of the Affordable Care Act are
implemented.
While the study found that high-severity emergency department visits of
low-income enrollees in high-deductible plans fell to 30 percent in the first
year and hospitalizations fell by 23 percent, both rose in the second year. The
researchers saw no such trend among high-income enrollees.
"Our findings suggest that plan members of low socioeconomic status at small
firms responded inappropriately to high-deductible plans and that initial
reductions in high-severity ED visits might have increased the need for
subsequent hospitalizations," the researchers concluded. "Policy makers and
employers should consider proactive strategies to educate high-deductible plan
members about their benefit structures or identify members at higher risk of
avoiding needed care. They should also consider implementing means-based
deductibles."
High-deductible healthcare plans also are contributing to job cuts in the healthcare sector, according to the latest
job cut report from Challenger, Gray & Christmas
Inc. FierceHealthcare previously reported. The plans are
discouraging consumers from seeking healthcare services, leading to less demand
for healthcare workers, the report said.